Harm reduction is not really about getting a user to see the harm s/he is causing others or society; it is about reducing the harm to society and the people involved with the client. Here's an example. Let's say someone with mental illness decides to go off their psych meds and starts using to self-medicate. Because using costs them their whole welfare cheque, they lose their home and end up homeless. Now the person is an untreated mental health patient who has addiction and is homeless. The cost to society for this person includes frequent trips to the ER, monitoring by public health and RCMP (the fentanyl crisis), the occasional Naloxone treatment, homeless shelters, soup kitchens, etc, and this cost is upward of $100,000 per year for one homeless person who is addicted and has mental illness. The idea is that if society provides housing, life skills, and monitoring, the cost to society would then be about $20,000 per year. Now we have reduced the harm to society by $80,000. Throw in a safe injection site, and now we have saved even more in terms of health care costs associated with HIV and HepC. That's a social action form of harm reduction, that still allows the user to use - since we can't make 'em quit, it gives them the autonomy to continue using in a way that is going to cause society the least amount of harm.
When it comes to a family situation where a parent is using, the harm reduction model says the parent can still use, but must make other arrangements for someone to care for the children until the user is clean again. This reduces, but does not eliminate, the harm caused to the children - to them, they are just going to visit auntie for the night, and they don't need to know mom is on a trip.
These types of actions reduce the harm to others (and in some cases by default, to the user). That is what it is intended to do, as well as create an environment that makes it safe for them to quit when and if they are ready for it. Part of harm reduction may include motivational interviewing to help the client recognize the harm they are doing to others, but may not include it. After all, these people likely already know they have done harm to others by virtue of being an addict. They do not deliberately want to create harm to their loved ones. In fact, many of them will break down crying when they talk about the pain they put their families through.
People who have addictions have them for a good reason. One study of Vancouver's Downtown Eastside suggests that every single addict there has come from a past of some sort of trauma. Their trauma is exacerbated when they start using and their family and friends start alienating them due to their use. These people are hurting and desperate for someone to reach out to them, connect with them, and care about who they are, no strings attached. Previous policies said that users had to be clean before they could access addiction services and counselling. The harm reduction model suggests that their immediate needs have to be met first, before they can even think about making steps towards recovery. They are living in their survival and emotional brain. Once the survival and emotional needs are met, only then will they be able to address their addictions with their thinking brain.
I had a professor who wrote her dissertation on the early stages of harm reduction in the Downtown Eastside. Harm reduction is a huge success in reducing the harm to society.
